ABSTRACT
Uterine leiomyomas, or fibroids, are the most common benign tumours of the female genital tract. Although uterine fibroids are commonly associated with menorrhagia, dysmenorrhea, symptomatic anaemia, urinary or bowel symptoms and infertility, intra-abdominal haemorrhage is an exceedingly rare complication. Often, the diagnosis is poorly recognizable based on the patient's clinical presentation and alternative diagnoses such as ruptured ectopic pregnancy, ruptured ovarian cyst or perforated viscus are frequently considered. Herein, we describe a case of a 50-year-old perimenopausal woman who presented with acute, lower abdominal pain, evolving anaemia, hypovolaemic shock and haemoperitoneum with no discernable source. Emergency exploratory laparotomy confirmed the source of massive haemoperitoneum arising from a ruptured blood vessel supplying a large subserosal uterine leiomyoma and the patient subsequently underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Given the paucity of publications on this clinical entity, the aim of this report is to highlight a rare complication of uterine leiomyomas, its pathophysiological spectrum and its relevance to emergency physicians, general surgeons and gynaecologists.
ABSTRACT
UNLABELLED: To evaluate the impact of health promotional strategies against The Acquired Immune Deficiency Syndrome (HIV/AIDS) in Trinidad and Tobago. METHODS: The HIV/AIDS Morbidity and Mortality reports were used to chart the pattern of change in the incidence of new HIV positive cases for the years 2000-2007 to determine the decrease in new HIV positive cases after 2004 with the implementation of the National Strategic Plan as well as What's Your Position (WYP), KNOW Your Status and Get Tested Now campaigns. These effects were tested using a quasi-experimental, post exposure design. A cross-sectional survey using street intercept interviews provided data on intervention effectiveness. Logistic regression analysis was used to determine the impact of HIV/AIDS campaigns, using their respective objectives. RESULTS: The study showed that a 16% decline in new HIV positive cases began during 2003 and 2004 and continued to decline by smaller margins until 2007. Data collected from the 599 participants with exposure to at least one campaign found that 92.7% reported awareness of WYP, followed by GTN (71.1%), RIU (42.6%), KYS (38.4%) and OUCH! (8.5%). 23.7% participants reported condom use post program exposure, whereas 19.0% practiced informed abstinence. A relationship was found between KYS and HIV/ AIDS Testing (p = .016) and between RIU and increased condom use (p = .010). CONCLUSIONS: Since the implementation of the programs, there have been positive lifestyle modifications among the sample population. Particularly "WYP" has been particularly effective in increasing awareness of practicing abstinence, faithfulness to one partner, condom usage when applicable, knowing their HIV status and further educating themselves about HIV/AIDS.
